Various

“ Our disappointment, too, is enhanced when we find the author, in many instances, limiting himself to the vaguest of generalities, and, while sceptical as to opinions which do not coincide with his own ideas, credulous to a high degree on some points of traditional medicine. The only methods of treatment on which Dr. Duncan at all dwells are those of leeching and poulticing—save that, in a few words on internal remedies, he urges the use of mercury to produce slight salivation, and rejects, what many think so valuable, the employment of opium. ”

“ The Pressure and Ligature Methods of treating Aneurism.—In the course of a lecture on aneurism of the femoral artery Mr. Paget, adverting to these two methods, speaks of them thus: “Taking large numbers of cases of aneurism together, they are very nearly balanced, on the one side for pressure, and on the other for ligature. In favour of pressure there is the experience of the surgeons in Dublin. They seem to have a much larger number of aneurisms, especially of aneurisms of the popliteal artery, to treat than we have in England, and they have certainly a large amount of success. ”

“ It is a common fault, not so much perhaps in hospital as in private practice, not to give a poultice the chance of curing a local inflammation by limiting its application to the part affected. A poultice to be of any use should widely cover the tissues which surround the seat of inflammation; for example, if the hand is inflamed the poultice should not only completely envelope it, but should extend at least half-way up the fore-arm: and this rule holds good especially when poultices are used for superficial or for subcutaneous diffused inflammation. ”

“ When the authority of the ancients is invoked to determine any procedure in medical practice, we must remember that their idea of what constituted disease consisted in the symptoms it manifested. When, therefore, a symptom was diminished or removed, they regarded the means they employed as having diminished or removed the disease. That a blood-letting relieves the pain and dyspnœa in pneumonia is an unquestionable fact. If employed early, it is true the symptoms returned, and the remedy had to be repeated ”

“ Such was the unacquaintance of the past race of practitioners with diagnosis and pathology as now understood, that no confidence whatever can be placed on their impressions as to what disorders were or were not benefited by bleeding.
That in certain cases a full blood-letting modifies or cuts short symptoms, I agree with Dr. Richardson in thinking is just as manifest a truth now, as it was to Galen or Cullen. ”

“ In May 1868 I was consulted by a gentleman of 19, whose father died of phthisis. He had been steward on board a packet plying between Liverpool and New York; got wet through on his last voyage, lung symptoms soon set in, and he considers that his present ones date from three months ago. He has constant cough, for which he can get no relief, profuse sweatings, hectic, and extreme emaciation; in short, all the ordinary signs of softening tubercle in the right apex, and had been sent home by medical men in Liverpool to Handsworth,—just to die. ”

“ The danger of asphyxia increases every moment, and it is necessary to have ready the means of throwing in a stream of pure air or of oxygen, through the nose, sprinkling the patient with cold water at the same time. Nagel has also observed that the restlessness and oppression produced by half-felt pain in incomplete narcosis, and the consequently insufficient respirations, may produce an even fatal exhaustion. Narcosis should therefore be properly kept up as long as it is wanted. ”

“ He thus expresses himself as to the necessary qualities of the ligature:—“The method which I have found to answer best is to keep the gut steeped in a solution of carbolic acid in five parts of olive oil, with a very small quantity of water diffused through it.” A larger proportion of the acid would impair the tenacity of the thread. If a mere oily solution is employed, the gut remains rigid, the oil not entering at all into its substance. But a very small quantity of water, such as the acid enables the oil to dissolve, renders the gut supple without making it materially weaker or thicker. ”

“ It must not be supposed, however, that therapeutics are neglected, or sacrificed to etiology. Both author and editor give us a very full account of the remedies now in vogue, and of their own clinical observations. We have not seen anything on the subject of the hypodermic employment of mercury, but the internal administration of the salts of mercury and iodide of potassium is of course enjoined. Indeed, the chapters on the treatment of syphilis are not the best. ”

“ That it may be complicated with various diseases, and be associated with strength or weakness of the individual attacked, is no proof of any specific change in the disease itself. In this respect it is in no way different at present from what it has ever been. Then, as to treatment, can it be seriously maintained that the low diet in the first case, that the loss of six ounces of blood in the second, or the six leeches and other treatment in the two others, benefited the pneumonia and hastened its resolution? ”

“ To refer to the opinions of the ancients is, as we have seen, useless; and to support their notions by citing one or two exceptional cases is of no advantage whatever. Indeed the quotation of successful cases, without also stating the failures that have been experienced, is the chief cause of the imperfection of practical medicine. It has been demonstrated that when the practice of bleeding in acute pneumonia was universal, the result was one death in three cases. ”

“ All surgeons are familiar with the good results which follow the application of a poultice to an acutely inflamed surface-part. Quite recently a woman has been under my care with inflammation of the tissues about the internal saphenous vein. She has progressed quite well towards convalescence by keeping the limb at rest, and by having the inflamed vein-track covered with a large poultice of linseed meal; no other treatment has been required. ”

“ ON THE THERAPEUTICAL VALUE OF THE INHALATION OF OXYGEN GAS.
BY EDWARD MACKEY, M.B. LOND. ETC.
Joint Professor of Materia Medica and Therapeutics in Queen’s College, Birmingham. Our ordinary medicinal agents are substances from the animal, the vegetable, and the mineral kingdoms: the one here to be treated of is of that class of remedies which includes the great elements or forces of nature: such are water, in all the varied forms of bath; electricity, in its different developments; air, in all its modifications of pressure or composition. ”

“ But with regard to the treatment of acute pneumonia I regard the following axioms as fully established, viz.:—
1. The great end of medical practice is to remove the consolidation of the lungs and restore those organs to their natural condition as rapidly as possible.
2662. To this end everything that diminishes vital strength should be avoided, and nutrients administered as early as possible, to favour the cell transformation necessary for removing the exudation from the lungs.
3. There is no relation between the violence of the symptoms or force of the pulse and the fatality of the disease. ”

“ The benefit of fresh air in the more obstinate forms of the disease is well known; but it is often difficult to convince parents that exercise in the fresh air will benefit the child. They imagine that it is rather hurtful than otherwise, because the intolerance of light is then a distressing symptom, proper means not having been taken to shade the eyes. ”

“ The chief obstacle to obtaining accuracy in result is the general conviction among medical practitioners that a different treatment is required, even in fixed morbid conditions, according to the symptoms which may be present. The progress of diseases is never absolutely uniform, and no doubt the occurrence of particular phenomena often require special interference. This secondary treatment of symptoms, however, should never be allowed to interfere with the primary management of the morbid condition ”

“ To resume: 12 cases are here related; 2 of the 12 are of organic, and in all probability incurable disease, and these 2 derived little or no benefit from the inhalation of oxygen; the other 10 found benefit as recorded, some more, some less, but all of a kind which I have not seen given by medicine alone. It remains to ask—Is there any common character by which we may connect together this series of cases, and which may enable us to say, oxygen is good for such and such a class of cases, as we say iodide of potassium or quinine is good for such and such a class? ”

“ Barnes read a paper, in which he described a new operation for the relief of chronic inversion of the uterus. He gave the statistics of the different methods now in use. He stated that the ligature and excision were open to the double objection that, besides being very hazardous to life, success was only achieved at the expense of mutilating the patient. Forcible taxis was a violent and often fatal proceeding. Sustained elastic pressure had given remarkable results, but cases would occur where the constricted cervix uteri would resist simple pressure. ”

“ In those days practitioners triumphantly pointed to the two cases out of three that they snatched from what was then considered a fatal attack of illness. Indeed it might easily be shown that the worst practice might be defended by what are called successful cases. So far from two survivors out of three being good practice, we have seen that the abandonment of blood-letting and the adoption of a restorative plan of treatment has resulted in diminishing the mortality to one in twenty-seven or thirty cases. ”

“ Young and vigorous subjects suffer most, but almost always recover soonest.
4. The weak pulse, want of reaction, non-disappearance of the pneumonic consolidation, or its appearance during the progress of exhaustive diseases, are the unfavourable signs of pneumonia.
5. Continued exercise or work after the attack; low diet, large blood-lettings; depressants, such as tartar emetic and sedatives; expectorants, such as squills and ipecacuanha; mercury and violent purgatives, are opposed to the restorative treatment of the disease, and when not fatal, tend to prolong its duration. ”

“ It has been asserted that poultices are often used to conceal defects of treatment, a kind of refuge in ignorance of any more advantageous applications, and that they often do positive harm by inciting profuse, and consequently exhausting, suppuration, and, no doubt, it is true they favour the tendency to suppuration which may exist in particular instances, and that they will increase a suppurating discharge when the latter is already established.
Most remarkable results, however, follow the use of poultices in certain cases—of lupus, for example. ”

“ While the fact is, that in cases of diarrhœa that are caused or kept up by the poisonous effect of sulphuretted hydrogen, I have given bismuth, combined with a few grains of Dover’s powder, with more real benefit to the disease than any drug I could administer. Opium alone is useless, or worse. Charcoal, by absorbing the gas, has been, next to bismuth, the most beneficial. Chambers on ‘Indigestions’ says that it is ‘rare to find sulphuretted hydrogen or hydro-sulphate of ammonia excreted without watery or soft pultaceous stools. ”

“ Before proceeding to active treatment, instructions regarding diet, regulation of the bowels, &c. should be given. The diet should be plentiful, simple, and nutritious; and all articles of food likely to unduly tax the digestive powers (which are as a rule weak in such children) should be carefully avoided. Strict attention should be paid to the bowels, which ought to be opened at least once during each day, but oftener if the appetite be faulty, the tongue loaded, and the fæces light coloured and of bad odour. ”

“ The chest symptoms continued so bad as to confine him to the house for three or four months; afterwards, he seemed gradually to recover under the use of tonics and cod oil, and the influence of a warmer climate, and when he came to me in January 1869 for the first time, he looked well; however, he complained of debility, of constant dyspnœa on exertion, and of exaggerated attacks of it occurring suddenly at times, of some cough and of glutinous expectoration; if he attempted to live well, as he had been told to do—meaning especially the taking of wine—he usually got an attack of epistaxis. ”

“ The term hæmorrhoid or pile being used to signify a tumour caused by enlarged or varicose veins at the lower part of the rectum, the definition of the disease would seem to indicate its treatment—pressure and support. The benefit resulting from pressure on tumours, and from pressure and support applied to varicose veins situated on the surface of the body, is manifold and manifest. The same good results often attended 319pressure internally applied in cases of hæmorrhoids, and frequently in cases of prolapsus also. ”

“ She took eight inhalations at intervals of two days, and then found the above symptoms so much relieved as to be able to omit all treatment for a time. She herself attributed great benefit to the gas, and was taking no other special medicine at the time. Since then she has borne fairly well the cares of a large family. She has gained flesh, and though there is still a frequent cough, and sputum, and a mucous râle about the left apex (I examined the chest two days ago) , the progress of the disease is arrested for a time at least. ”

“ Small blood-lettings of from six to eight ounces may be used in extreme cases, more especially of double pneumonia or of broncho-pneumonia, as a palliative to relieve tension of the bloodvessels and congestion of the right heart and lungs.
7. Local pain is best relieved by large warm poultices.
8. The true disease, that is, the exudation which has infiltrated itself through the pulmonary tissues and been coagulated, constituting hepatization, can only be removed, first, by its transformation into pus cells ”